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Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference

Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference

The notion that compassion makes a big difference in how well someone heals from illness or injury may be a big “duh!” for most of us. 

People don’t care about how much you know until they know how much you care.

– Theodore Roosevelt

Two physicians, Stephen Trzeciak, an intensive care specialist and chair of medicine at Cooper Medical School of Rowan University (and much more) and Anthony Mazzarelli, an ER doc and co-president of Cooper University Health Care (and much more) spent two years doing a thorough and systematic review of all of the scientific research studies on compassion in health care to date, hundreds of studies for the last 50 years, conducted by researchers in the nation’s top medical schools and universities and published in top-ranking professional journals. They have written Compassionomics; The Revolutionary Scientific Evidence that Caring Makes a Difference to demonstrate – “beyond irrefutability” – that compassion matters in health care in meaningful and measurable ways. And to push for a top-to-bottom revolution in the health care industry based on the meticulousness of their findings:

* The presence of compassion has the power to improve patient outcomes, and its absence can lead to devastating, even fatal consequences.

* Compassionate behaviors are a health care provider’s responsibility. (Once you see the pattern in the data, it is impossible to unsee it.) 

* Providers can create a compassionate connection with a patient in (on average) 40 seconds

* Compassion can be learned; it’s an essential part of every health care provider’s toolbox

The definition of compassion that scientists used in the studies and that we can intuitively resonate with: an emotional response to another’s pain or suffering, involving an authentic desire to help.

Even though the American Medical Association’s principles of medical ethics states: “A physician shall be dedicated to providing competent medical care with compassion,” not all health care providers are trained, mentored, or monitored to do so. 

A positive example of compassion from the book: the script used with newly diagnosed cancer patients in their initial consultations at Johns Hopkins University: 

I know this is a tough experience to go through and I want you to know that I am here with you. some of the things that I say to you today may be difficult to understand, so I want you t feel comfortable in stopping me if something I say is confusing or doesn’t make sense.  We are here together, and we will go through this together.  

These words demonstrably reduce the patient’s anxiety and they take less than 40 seconds.

Though Compassionomics was written to radically transform the practice of medicine by providers in today’s health care system, the data is so clearly presented, the concepts are so easy to grasp, the stories of patients and providers navigating the “compassion crisis” so compelling, (really the heart and soul of the data) I heartily recommend you at least peruse the main concepts.  You’ll find yourself and people you care about in many of the findings.

Main points covered in Compassionomics.  (And remember, the science behind these conclusions is solid.)

Physiological benefits of compassion

  • Compassion builds human connection and trust
  • Compassion calms the stress response
  • Compassion lowers blood pressure
  • Compassion enhances immune function
  • Compassion helps wounds heal faster
  • Compassion reduces perception of pain
  • Compassion reduces back pain
  • Compassion reduces headache and IBS pain
  • Compassion improves symptoms of the common cold
  • Compassion reduces serious diabetes complications
  • Compassion promotes healing from trauma
  • Compassion improves quality of life in palliative care

An example from Dr. Alann Solina, chair of the department of anesthesiology at Cooper University Health Care, providing anesthesia to more that 25,000 surgery patients:

When I am able to build a bond with a patient ahead of surgery, where I show that I care about them and they put their trust in me, I find that they actually need a lower amount of sedatives ahead of surgery and oftentimes none at all.  When we wheel them into the operating room, they are much more likely to be peaceful and calm. 

Psychological benefits of compassion 

  • Compassion can alleviate distress
  • Compassion for others can alleviate depression
  • Compassion can alleviate anxiety
  • Compassion can help treat PTSD
  • Compassion, with early intervention in an medical emergency, may help prevent PTSD

From Kenneth Schwartz, cancer patient:

For as skilled and knowledgeable as my caregivers are, what matters most is that they have empathized with me in a way that gives me hope and makes me feel like a human being, not just an illness.  Again and again, I have been touched by the smallest kind gestures, a squeeze of my hand, a gentle touch, a reassuring word.  In some way, these quiet acts of humanity have given more healing than the high-dose radiation and chemotherapy that hold the hope of a cure.

Impact of compassion on patient self-care

  • Compassion promotes adherence to medication protocols
  • With compassion, patients feel empowered to cope with, understand, and manage their illness

Compassion is one of the impulses that nature has implanted in us to do what our duty alone may not accomplish.

– Immanuel Kant

Impact of compassion on quality of care

A personal connection is integral to compassion. It’s not possible to have compassion for another person if there is an inability to see others’ humanity on a personal level.

  • Compassion elevates the quality of care
    • Providers going the extra mile
    • More diligence and meticulousness around care
    • Higher levels of trust, creating better therapeutic alliance
    • Better communication
    • More patient self-disclosure, clearer information and better diagnoses
    • Patients more likely to believe the provider knows what they are doing
  • Physician compassion lowers the odds of committing a major medical error
    • Do no harm: A lack of compassion can pose a safety risk to patients
    • Not seeing a patient as a person prevents compassion
    • Lack of provider compassion cause emotional harm to patients

Compassion Drives Revenue Up… 

Health care consumers view health care first and foremost as a personal interaction and not just a medical transaction

  • Patients choose and recommend providers based on satisfaction with relationship
    • The provider listens
    • The provider is caring and compassionate
    • The provider explains well
  • Patients perceive compassionate providers to be more competent
  • Patients are willing to pay more for compassionate care

…and Costs Down

  • Compassionate physicians refer less and order fewer tests
  • Compassionate care drives costs lower through better adherence to clinical recommendations
  • Compassionate culture reduces employee absences, sick days, and medical leaves
  • Compassionate care lowers malpractice costs

Compassionomics was published in May 2019, pre-COVID. Can the science and stories presented in 

Compassionomics transform our health care system any time soon?

Many physicians are on board.  From the endorsement of Beth Lown, M.D. associate professor of medicine at Harvard Medical School and chief medical officer at the Schwartz Center for Compassionate Healthcare:

So why does compassion remain on the sidelines as ‘nice,’ but not absolutely essential, in the ways we train health care professionals and teams and in how we deliver and evaluate health care organizations an systems?  Drs. Trzeciak and Mazzarelli are trying to rectify this. By sharing stories about illness alongside highly readable summaries of decades of scientific research, they make a compelling case that compassion is vital to our collective health and well-being.  Perhaps heightened public and professional awareness of the value and importance of compassion will enable us to raise our voices together to insist that compassion is a necessity, not a luxury, in health care. 

I recommended Compassionomics to my physical therapist (shoulder fracture). He promptly read it, grokked it, and is conducting an in-service training at his hospital.

Kristin Neff, whose research on self-compassion is cited in the book, has launched a Self-Compassion for Health Care Communities training through the Center for Mindful Self-Compassion. 

It’s possible.  It may even be probable.  There is hope.  

I close with this story from the book – touching and an exemplar of compassion in action.

One night a 60-year-old man was admitted to the ICU at Cooper University Hospital due to a spontaneous brain hemorrhage.  Sadly, the bleeding was so severe that there was nothing the neurosurgeons could do to save him.  He was dying, and rapidly declining with only hours to live.

But that was not the only tragedy: His grief-stricken wife relayed the story that the patient’s daughter, who was on her way to the hospital with her fiancée, was to be married in just two weeks.  She said it was going to be the highlight of the patient’s life. She begged the ICU team to do whatever they could to keep him alive until the daughter arrived.

His daughter – who was of course, devastated by the news that her dad was so gravely ill – was praying there was some way that he could be there when she got married.  It was a heartbreaking scene when the daughter and her fiancée arrived in the ICU, saw his life slipping away, and realize that their dream wedding day would not include him. 

That was when the ICU nurses and technicians on duty that night – moved by deep compassion for this patient and his family in their moment of tragedy – sprang into action…as wedding planners.

It was 2a.m, and they did not have much time. An ICU nurse crafted two rings out of IV tubing and medical tape.  Two ICU technicians quickly scoured the hospital for the rest of the essentials. The cancer unit had a beautiful bouquet of flowers that they gladly donated.  There was a frozen pound cake in the back of the freezer of the staff break room that was fashioned into a wedding cake. Something blue?  They borrowed a blue ribbon from some Easter decorations on another floor.

But who was going to marry them?  They called the clergy on-call, but since it as 2am and Dad was fading fast, it looked like the chaplain would not make it in time. Just then, one of the other ICU nurses stepped forward.  He was an ordained minister and able to perform weddings.

Imagine the scene: With wedding music playing from a nurse’s cell phone, and the family (including the bride’s sister who was on speaker phone from California) plus the entire ICU staff gathered around Dad’s bedside, there was a wedding.  It was not the wedding that was planned, but it was nonetheless beautiful.

In her father’s presence (and holding his hand) the bride and groom said their vows.  Minutes later, he died.  The patient and family went through unspeakable pain in the ICU that night.  But the compassion that the ICU staff showed them was something that no one will ever forget. 

Weeks later, the bride wrote a very touching letter to the ICU staff, thanking them for all their compassion and for going the extra mile to allow her to be married in her father’s presence.  It meant the world to her. She concluded the letter:

Thank you, from the bottom of my heart.  Although my heart is broken, at the same time, because of you, it is very full.

Compassion makes the unbearable, bearable.  May it be so.

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